Search

Dear Editor, The current pandemic of COVID-19 demanded fast reorganization, as well as the necessity to adapt existing and administered extraordinary working protocols of dermatological services worldwide.1 We present a unique experience from Republic of Macedonia where an abrupt interruption of the dermatology service on a national level, and the COVID-19 outbreak, occurred simultaneously, with a significant impact on the quality of care. The fourth diagnosed case of COVID-19 in the Republic of Macedonia was a dermatologist employed at the University Clinic for Dermatology in Skopje, the only tertiary care hospital in the country. Prior to being diagnosed, the doctor made direct contact with nearly all medical and non-medical personnel of the Clinic. The doctor also held a previously scheduled seminar, which was attended by an additional 95 dermatologists and dermatology residents from across the country. In the first hours following the diagnosis, rapid action was taken by government officials, and 128 dermatologists and dermatology residents were put in home quarantine for 14 days. Only 9 dermatologists in secondary care could resume practice in the period from 9 March 2020 to 26 March 2020, unevenly distributed geographically and in terms of subspecialty. At the same time, a number of socially restrictive measures were implemented, further reducing the availability of the dermatological services. The Macedonian dermatological body reacted with notable initiative and self-organization. In the absence of an official teledermatology platform, commonly used social media platforms and conventional telecommunications were used to sustain communication with other specialties and patients. As a result, the management of the majority of chronic patients proceeded without interruption. In an effort to discover which of the dermatological conditions demanded immediate attention, we conducted a survey where we asked colleagues about the number and reasons for teledermatological consults. Overall, 77 dermatologists participated in the survey. Ninety-one percent of respondents had received requests for consultations by patients. Eighty-two percent felt that consultation via a communication application was useful for patient follow-up; however, these methods were appropriate in less than 30% of cases for initial consultations. The most common motives for consultations with patients were therapy follow-ups, acute exacerbations of chronic diseases, and deficiencies of certain medications due to difficulties in drug importations. Most frequently, dermatology input was requested from general practitioners (GPs) and pediatrics (Table 1). The dermatologists, who were not subject to the home isolation measure, held 163 outpatient examinations, in the majority of which pediatric dermatological pathology dominated (Table 2). A total of 11 patients were admitted during this period in a secondary care hospital; the most frequent admissions were for bullous dermatoses and cutaneous infections (Table 2). Korting, Hammerschmidt, and Miovski constituted the initial development of the University Clinic for Dermatology in 1947, as part of the Medical Faculty in Skopje,2 with the treatment of the vast number of patients with skin infections as its main purpose.3,4 Since then, TABLE 2 Undelayable visits and admissions in 2 weeks period Outpatient visits N = 163 Primary reason for admission to hospital N = 11 Pediatric (

Quality of life is defined by the World Health Organization as "individuals' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns." Often overlooked in the past, it is nowadays considered, in a more holistic view of medicine, a decisive factor to understand the impact of diseases and improve the quality of medical care. Such evaluation is particularly relevant for dermatological diseases, because visibility of the lesions can significantly affect self-esteem and social relationships. Vitiligo represents an emblematic case: often disfiguring and located in visible areas, confused in the past (and, in many world regions, even in the present) with leprosy, often perceived by physicians as a harmless, purely cosmetic problem, it significantly decreases the quality of life of affected persons. After a brief overview on definition, usefulness and methods for the assessment of quality of life, the authors examine the peculiarities of its relationship with skin diseases, particularly vitiligo. The state of the art of knowledge and research in this field is presented, together with data showing usefulness and positive results of a multidisciplinary approach, which adequately keeps into account perceived quality of life, on patient's satisfaction, adherence to treatment protocols and, ultimately, better outcome of treatments. In this context, an important role can be played by support communities, groups of patients and dedicated associations and societies, connected through modern communication networks like the Internet.

Vitiligo is a manageable disease. However, current vitiligo treatments can be considered suboptimal as they do not guarantee high efficacy and cannot be standardized for most patients. Recently, combination therapies have been introduced in order to obtain better results and reduce risks in the management of the disease. Novel efficacious products are hereunder discussed to improve the therapeutic options for vitiligo patients.